Provider Demographics
NPI:1689629701
Name:BOSLER, NANCY W (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:W
Last Name:BOSLER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9505 WILLIAMSBURG PLZ
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-5082
Mailing Address - Country:US
Mailing Address - Phone:502-412-2995
Mailing Address - Fax:502-412-8025
Practice Address - Street 1:9505 WILLIAMSBURG PLZ
Practice Address - Street 2:SUITE 201
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-5082
Practice Address - Country:US
Practice Address - Phone:502-412-2995
Practice Address - Fax:502-412-8025
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1025420363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78006871Medicaid
KY50001582OtherPASSPORT PROV NUMBER
KY00000024208OtherANTHEM PROV NUMBER
KY24431590000OtherPASSPORT ADV. PROV NUMBER
KY50001582OtherPASSPORT PROV NUMBER
KY0568905Medicare ID - Type UnspecifiedPROVIDER NUMBER